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CLEMENTS CUSTOM GUNS ORDER BLANK

DATE ____________

NAME ___________________________________

ADDRESS ___________________________________________

CITY __________________STATE ________ZIP __________

PHONE NO. ____________________

EMAIL _________________________________

SERIAL NO. OF GUN SENT ______________MFG. AND MODEL______________

BARREL LENGTH WANTED ___________________FINISH __________

RETURN TAKEOFF PARTS Y/N_________________

INSTRUCTIONS AND OPTIONS


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AMOUNT OF PAYMENT ENCLOSED ___________________

UPS & USPS shipping address:     Clements Custom
                                         2766 Mt. Zion Road
                                         Woodlawn,Va. 24381